Normadate

Normadate Uses, Dosage, Side Effects, Food Interaction and all others data.

Normadate competitively inhibits the adrenergic stimulation of β-receptors within the myocardium, bronchial and vascular smooth muscle, and α1-receptors w/in vascular smooth muscle. It also has some intrinsic β2-agonist and membrane-stabilising activity.

The capacity of labetalol HCl to block alpha receptors in man has been demonstrated by attenuation of the pressor effect of phenylephrine and by a significant reduction of the pressor response caused by immersing the hand in ice-cold water (“cold-pressor test”). Normadate HCl's beta1-receptor blockade in man was demonstrated by a small decrease in the resting heart rate, attenuation of tachycardia produced by isoproterenol or exercise, and by attenuation of the reflex tachycardia to the hypotension produced by amyl nitrite. Beta2-receptor blockade was demonstrated by inhibition of the isoproterenol-induced fall in diastolic blood pressure. Both the alpha- and beta-blocking actions of orally administered labetalol HCl contribute to a decrease in blood pressure in hypertensive patients. Normadate HCl consistently, in dose-related fashion, blunted increases in exercise-induced blood pressure and heart rate, and in their double product. The pulmonary circulation during exercise was not affected by labetalol HCl dosing.

Single oral doses of labetalol HCl administered to patients with coronary artery disease had no significant effect on sinus rate, intraventricular conduction, or QRS duration. The atrioventricular (A-V) conduction time was modestly prolonged in two of seven patients. In another study, IV labetalol HCl slightly prolonged A-V nodal conduction time and atrial effective refractory period with only small changes in heart rate. The effects on A-V nodal refractoriness were inconsistent.

Normadate HCl produces dose-related falls in blood pressure without reflex tachycardia and without significant reduction in heart rate, presumably through a mixture of its alpha- and beta-blocking effects. Hemodynamic effects are variable, with small, nonsignificant changes in cardiac output seen in some studies but not others, and small decreases in total peripheral resistance. Elevated plasma renins are reduced.

Normadate antagonizes various adrenergic receptors to decrease blood pressure. The duration of action is long as it is generally given twice daily, and the therapeutic window is wide as patients usually take 200-400mg twice daily. Patients susceptible to bronchospasms should not use labetalol unless they are unresponsive to or intolerant of other antihypertensives.

Trade Name Normadate
Availability Prescription only
Generic Labetalol
Labetalol Other Names Labetalol, Labétalol, Labetalolum, Labetolol
Related Drugs amlodipine, lisinopril, metoprolol, losartan, furosemide, hydrochlorothiazide, propranolol, atenolol, hydralazine, nifedipine
Type Tablet
Formula C19H24N2O3
Weight Average: 328.4055
Monoisotopic: 328.178692644
Protein binding

Labetalol is approximately 50% protein bound in serum.

Groups Approved
Therapeutic Class Alpha adrenoceptor blocking drugs, Beta-adrenoceptor blocking drugs
Manufacturer Glaxosmithkline
Available Country India,
Last Updated: September 19, 2023 at 7:00 am
Normadate
Normadate

Uses

Normadate Hydrochloride is used for the control of all grades of hypertension including-

  • Pregnancy-induced hypertension
  • The treatment of angina in patients with hypertension
  • Where a hypertensive technique is used for anesthesia
  • The management of catecholamine excess and patients with pheochromocytoma.

Normadate is also used to associated treatment for these conditions: Chronic Stable Angina Pectoris, High Blood Pressure (Hypertension), Hypertensive Emergency, Hypertensive crisis, Pheochromocytomas, Subarachnoid Hemorrhage

How Normadate works

Normadate non-selectively antagonizes beta-adrenergic receptors, and selectively antagonizes alpha-1-adrenergic receptors. Following oral administration, labetalol has 3 times the beta-blocking ability than alpha-blocking ability. This increases to 6.9 times following intravenous administration. Antagonism of alpha-1-adrenergic receptors leads to vasodilation and decreased vascular resistance. This leads to a decrease in blood pressure that is most pronounced while standing. Antagonism of beta-1-adrenergic receptors leads to a slight decrease in heart rate. Antagonism of beta-2-adrenergic receptors leads to some of the side effects of labetalol such as bronchospasms, however this may be slightly attenuated by alpha-1-adrenergic antagonism. Normadate leads to sustained vasodilation over the long term without a significant decrease in cardiac output or stroke volume, and a minimal decrease in heart rate.

Dosage

Normadate dosage

Oral-

Adult: The recommended initial dosage is 100 mg twice daily whether used alone or added to a diuretic regimen. After 2 or 3 days, using standingblood pressureas an indicator, dosage may be titrated in increments of 100 mg b.i.d. every 2 or 3 days. The usual maintenance dosage of labetalol HCl is between 200 and 400 mg twice daily.

Since the full antihypertensive effect of labetalol HCl is usually seen within the first 1 to 3 hours of the initial dose or dose increment, the assurance of a lack of an exaggeratedhypotensiveresponse can be clinically established in the office setting. The antihypertensive effects of continued dosing can be measured at subsequent visits, approximately 12 hours after a dose, to determine whether further titration is necessary.

Patients with severe hypertension may require from 1,200 to 2,400 mg per day, with or without thiazide diuretics. Should side effects (principallynauseaor dizziness) occur with these doses administered twice daily, the same total daily dose administered three times daily may improve tolerability and facilitate further titration. Titration increments should not exceed 200 mg twice daily.

When a diuretic is added, an additive antihypertensive effect can be expected. In some cases this may necessitate a labetalol HCl dosage adjustment. As with most antihypertensive drugs, optimal dosages of Normadate Tablets are usually lower in patients also receiving a diuretic.

When transferring patients from other antihypertensive drugs, Normadate Tablets should be introduced as recommended and the dosage of the existing therapy progressively decreased.

Elderly: As in the general patient population, labetalol therapy may be initiated at 100 mg twice daily and titrated upwards in increments of 100 mg b.i.d. as required for control of blood pressure. Since some elderly patients eliminate labetalol more slowly, however, adequate control of blood pressure may be achieved at a lower maintenance dosage compared to the general population. The majority of elderly patients will require between 100 and 200 mg b.i.d.

Injection-

Adults:

  • Bolus Injection: If it is essential to reduce the blood pressure quickly a dose of 50 mg should be given by intravenous injection (over a period of at least one minute) and, if necessary, repeated at five minute intervals until a satisfactory response occurs. The total dose should not exceed 200 mg.
  • Intravenous Infusion: For intravenous infusion the injection should be diluted with a suitable intravenous infusion fluid to a concentration of Normadate Hydrochloride 1 mg/1 ml. Compatible fluids include 5% Dextrose; 0.9% Sodium Chloride; Dextrose and Sodium Chloride.
  • Hypertension in pregnancy: Infusion should be started at 20 mg/hour, then doubled every 30 minutes until a satisfactory response is obtained or a dosage of 160 mg/hour is reached.
  • Hypertensive episodes following acute myocardial infarction: Infusion should be started at 15 mg/hour and gradually increased to a maximum of 120 mg/hour depending on the control of blood pressure.
  • Hypertension due to other causes: Infuse at a rate of about 2 mg/min until a satisfactory response is obtained, then stop infusion. The effective dose is usually 50-200 mg but larger doses may be needed, especially in patients with phaeochromocytoma. The rate of infusion may be adjusted according to the response at the discretion of the physician. Normadate injection has been administered to patients with uncontrolled hypertension already receiving other hypotensive agents, including b-blocking drugs, without adverse effects.
  • Hypotensive anaesthesia: Induction should be with standard agents (e.g. sodium thiopentone) and anaesthesia maintained with nitrous oxide and oxygen with or without halothane. The recommended starting dose of Normadate injection is 10-20 mg intravenously depending on the age and condition of the patient. Patients for whom halothane is contraindicated usually require a higher initial dose of Normadate (25-30 mg). If satisfactory hypotension is not achieved after five minutes, increments of 5-10 mg should be given until the desired level of blood pressure is attained. Halothane and Normadate act synergistically therefore the halothane concentration should not exceed 1-1.5% as profound falls in blood pressure may be precipitated.

Children: Safety and efficacy in children have not been established.

Side Effects

Adverse effects reported are postural hypotension (avoid upright position during and for 3 hours after intravenous administration), tiredness, weakness, headache, rashes, scalp tingling, difficulty in micturition, epigastric pain, nausea, vomiting, liver damage.

Toxicity

The oral LD50 in mice is 600mg/kg and in rats is >2g/kg. The intravenous LD50 in mice and rats is 50-60mg/kg.

Patients experiencing an overdose may present with excessive hypotension and bradycardia. Patients should be placed on their back with their legs raised to maintain perfusion of the brain. Oral overdoses may be treated with gastric lavage or emesis, bradycardia may be treated with atropine or epinephrine, cardiac failure may be treated with digitalis and a diuretic, hypotension may be treated with vasopressors, bronchospasms may be treated with epinephrine or a beta2 agonist, and seizures may be treated with diazepam.

Precaution

Patients with phaeochromocytoma, inadequate cardiac function and well-compensated heart failure, DM, nonallergic bronchospasm. Patients undergoing major surgery involving general anaesth. May mask symptoms of hypoglycaemia. Avoid abrupt withdrawal as it may exacerbate angina. Hepatic impairment. Elderly, pregnancy and lactation.

Interaction

Synergistic hypotensive effect with halothane. Increased absolute bioavailability with cimetidine. Decreased absolute bioavailability with glutethimide. Additive hypotensive effect with nitroglycerin. Increased incidence of tremor with TCAs. Increased risk of bradycardia and heart block with Ca channel blocker (e.g. verapamil, diltiazem).

Food Interaction

  • Take with or without food. The absorption is unaffected by food.

Normadate Alcohol interaction

[Moderate]

Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation.

Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

Caution and close monitoring for development of hypotension is advised during coadministration of these agents.

Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs.

Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

Normadate Cholesterol interaction

[Moderate] Beta-adrenergic receptor blocking agents (aka beta-blockers) may alter serum lipid profiles.

Increases in serum VLDL and LDL cholesterol and triglycerides, as well as decreases in HDL cholesterol, have been reported with some beta-blockers.

Patients with preexisting hyperlipidemia may require closer monitoring during beta-blocker therapy, and adjustments made accordingly in their lipid-lowering regimen.

Normadate multivitamins interaction

[Moderate] ADJUST DOSING INTERVAL: Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers.

The exact mechanism of interaction is unknown.

In six healthy subjects, calcium 500 mg (as lactate, carbonate, and gluconate) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of atenolol (100 mg) by 51% and 32%, respectively.

The elimination half-life increased by 44%.

Twelve hours after the combination, beta-blocking activity (as indicated by inhibition of exercise tachycardia) was reduced compared to that with atenolol alone.

However, during a 4-week treatment in six hypertensive patients, there was no difference in blood pressure values between treatments.

The investigators suggest that prolongation of the elimination half-life induced by calcium coadministration may have led to atenolol cumulation during long-term dosing, which compensated for the reduced bioavailability.

It may help to separate the administration times of beta-blockers and calcium products by at least 2 hours.

Patients should be monitored for potentially diminished beta-blocking effects following the addition of calcium therapy.

Volume of Distribution

In normotensive patients, the volume of distribution is 805L. In hypertensive patients, the volume of distribution is between 188-747L with an average of 392L.

Elimination Route

100mg and 200mg oral doses of labetalol have a Tmax of 20 minutes to 2 hours. Bioavailability may be as low as 11% or as high as 86% and may increase in older patients or when taken with food.

Half Life

Normadate has a half life of 1.7-6.1 hours.

Clearance

Normadate has a plasma clearance of approximately 1500mL/min and a whole blood clearance of 1100mL/min.

Elimination Route

Radiolabelled doses of labetalol are 55-60% recovered in the urine and 12-27% recovered in the feces.

Pregnancy & Breastfeeding use

Pregnancy Category C. Teratogenic studies were performed with labetalol in rats and rabbits at oral doses up to approximately six and four times the maximum recommended human dose (MRHD), respectively. No reproducible evidence of fetal malformations was observed. Increased fetal resorptions were seen in both species at doses approximating the MRHD. A teratology study performed with labetalol in rabbits at IV doses up to 1.7 times the MRHD revealed no evidence of drug-related harm to the fetus. There are no adequate and well-controlled studies in pregnant women. Normadate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nonteratogenic Effects: Hypotension, bradycardia, hypoglycemia, and respiratory depression have been reported in infants of mothers who were treated with labetalol HCl for hypertension during pregnancy. Oral administration of labetalol to rats during late gestation through weaning at doses of two to four times the MRHD caused a decrease in neonatal survival.

Labor and Delivery: Normadate HCl given to pregnant women with hypertension did not appear to affect the usual course of labor and delivery.

Nursing Mothers: Small amounts of labetalol (approximately 0.004% of the maternal dose) are excreted in human milk. Caution should be exercised when Normadate Tablets are administered to a nursing woman.

Contraindication

Obstructive airway disease (e.g. bronchial asthma), 2nd and 3rd degree heart block, cardiogenic shock, conditions with severe or prolonged hypotension, uncompensated heart failure, severe bradycardia.

Special Warning

Pediatric Use: Safety and effectiveness in pediatric patients have not been established.

Elderly Patients: As in the general population, some elderly patients (60 years of age and older) have experienced orthostatic hypotension, dizziness, or lightheadedness during treatment with labetalol. Because elderly patients are generally more likely than younger patients to experience orthostatic symptoms, they should be cautioned about the possibility of such side effects during treatment with labetalol.

Storage Condition

Store in cool dry place protected from light. Keep out of reach of children.

Innovators Monograph

You find simplified version here Normadate

Normadate contains Labetalol see full prescribing information from innovator Normadate Monograph, Normadate MSDS, Normadate FDA label

FAQ

What is Normadate used for?

Normadate is used to treat high blood pressure, including high blood pressure in pregnancy.

How safe is Normadate?

Normadate is generally safe to take for a long time. In fact, it works best when you take it for a long time.

How does Normadate work?

Normadate works by changing the way your body responds to some nerve impulses, especially in the heart. It slows down your heart rate and makes it easier for your heart to pump blood around your body. Normadate also works like an alpha blocker to widen some of your blood vessels.

What are the common side effects of Normadate?

Common side effects of Normadate are feeling dizzy or weak, itchy skin, a rash or tingly scalp, and difficulty peeing. These usually happen at the start of treatment and are short-lived.

Is Normadate safe during pregnancy?

Use of Normadate in pregnancy is common and there is no concern that it causes harm.

Is Normadate safe during breastfeeding?

If your doctor or health visitor says that your baby is healthy, it's  safe to take Normadate while breastfeeding.Normadate passes into breast milk in very small amounts. It's unlikely to cause any side effects in your baby.

Can I drink alcohol with Normadate?

Drinking alcohol can increase the risk of side effects with Normadate. It can make you feel dizzy or lightheaded. During the first few days of taking Normadate or after an increase in your dose, it's best to stop drinking alcohol until you see how the medicine affects you.

Can I drive after taking Normadate?

Do not drive or use tools or machinery if you're feeling dizzy.

What is the best time to take Normadate?

Take Normadate at a mealtime, or with something to eat.

How many hours does Normadate work?

Normadate starts to work within 2 hours, but it can take a few days to take full effect.

Does Normadate make me sleepy?

Normadate oral tablet may cause drowsiness with also cause other side effects.

How long does Normadate take to work?

Normadate starts to work within 2 hours, but it can take a few days to take full effect. You may not feel any different when you take Normadate, but this doesn't mean it's not working.

How long does Normadate stay in my system?

To prevent this, your doctor will reduce your dose gradually over 1 to 2 weeks before you can stop taking it. If you stop taking Normadate, it'll take a few days for it to be completely out of your body.

How is Normadate eliminated?

The metabolism of Normadate is mainly through conjugation to glucuronide metabolites. These metabolites are present in plasma and are excreted in the urine and, via the bile, into the feces.

Can I take Normadate for a long time?

If you're taking Normadate for high blood pressure or angina, treatment is usually long term. You may take it for the rest of your life. If you're taking it for high blood pressure during pregnancy, your midwife or doctor will check your blood pressure regularly.

Is Normadate hard on the kidneys?

Acute renal failure is uncommon in pure beta adrenergic blocker toxicity, but Normadate, with its alpha blockade, can lead to complex hemodynamic changes and can cause acute renal failure at toxic levels.

Can Normadate cause liver problems?

Normadate is an antihypertensive agent with both alpha and beta adrenergic receptor blocking activity.Normadate has been linked to several cases of clinically apparent drug induced liver disease, some of which have been severe and even fatal.

Can Normadate be taken once daily?

Normadate can be given once daily.

When should I not take Normadate?

You should not use Normadate if you are allergic to it, or if you have asthma.

What happens If I stop taking Normadate?

Stopping Normadate suddenly can cause an irregular fast heartbeat, high blood pressure, poor blood circulation to your heart, and can raise your risk of chest pain or heart attack. Work with your doctor to lower your dose slowly over time if you'd like to stop taking Normadate.

What happens if I miss a dose of Normadate?

If you miss a dose of Normadate, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

What happens if I overdose of Normadate?

Overdose symptoms may include slow heart rate, wheezing, chest tightness, trouble breathing, extreme dizziness, seizure, or fainting.

*** Taking medicines without doctor's advice can cause long-term problems.
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